The objective of this guideline is to provide healthcare professionals with practical guidance on the use of anti-D Ig as immunoprophylaxis to prevent sensitisation to the D antigen during pregnancy or at delivery for the prevention of HDN.
Prior to the availability of anti-D immunoglobulin (anti-D Ig), the incidence of Rh D alloimmunisation in D negative women following two deliveries of D positive, ABO-compatible, infants was approximately 16%, and haemolytic disease of the fetus and newborn (HDN) due to anti-D was a significant cause of morbidity and mortality (Urbaniak & Greiss, 2000). Following routine post-partum administration of anti-D Ig, the rate of alloimmunisation dropped to approximately 2%. A further reduction in the sensitisation rate ranging from 0·17 to 0·28% was achieved by introducing routine antenatal prophylaxis during the third trimester of pregnancy (Tovey et al., 1983a,b; Huchet et al., 1987; Mayne et al., 1997; MacKenzie et al., 1999). Associated with this reduction in sensitisation is a reduction in mortality associated with HDN, from 46/100 000 births to 1·6/100 000 births (Pilgrim et al., 2009).
These findings contributed to the National Institute for Clinical Excellence (NICE) recommendation that all D negative pregnant women who do not have immune anti-D, should be offered additional routine prophylaxis with anti-D Ig during the third trimester of pregnancy (NICE, 2002, 2008).
Declaration of Interests
The BSH paid the expenses incurred during the writing of this guidance. None of the authors had conflicts of interest to declare. All authors have made a declaration of interests to the BSH and Task Force Chairs which may be viewed on request.